1. Field of the Invention
This invention relates generally to surgical support devices for positioning and retaining a patient in a position lying on one side during hip or pelvic surgery. More particularly to a hip grip table apparatus that attaches to an operating table and has a removable top platform for supporting surgical instruments that extends over and protects the upper body of a patient lying on one side, an arm support attachment that supports an arm of the patient to prevent rolling, and pelvic positioner attachments that position and retain and the patient's lower pelvic region.
2. Brief Description of the Prior Art
Typically in surgical procedures such as hip and pelvic surgery, the patient is supported in a position lying on one side on an operating table, known as the lateral decubitis position, to facilitate a surgical procedure such as hip anthroplasty. In such procedures, it is extremely important to retain the patient in a fixed reference position relative to the operating table in order to achieve optimum fit and function of a hip prosthesis. In most instances the patient is under general anesthesia and cannot cooperate in maintaining the proper position.
A variety of patient support devices are known in the art for use in supporting a surgery patient in a position lying on one side (lateral decubitis position) on an operating table during hip or pelvic surgery. Some support devices, such as pelvic positioners or lateral positioners are mounted by clamps or other means onto opposed sides or side edges of the operating table. Conventional pelvic positioners have a pad supported at one end of an elongate rigid rod or arm that is clamped to the side edges or to rails or grooves on the opposed sides of the table by clamps. The opposed pads engage the anterior and posterior pelvic region of the patient and usually are in contact with the soft tissues in the pelvic region, resulting frequently in inadequate patient support and retention.
These conventional pelvic positioners or lateral positioners are not particularly suited to support the upper body of the patient who, in the lateral decubitis position, also has one shoulder on the table and the other shoulder extending vertically upward. The sedated or unconscious patient has no muscle control and often the upper body will tend to roll to one side or the other even the the pelvic region may be retained. The upper body is often supported by pillows. The arm on the elevated side of the body is heavy and difficult to properly position, and is often tied to one side of the table.
Another problem with conventional pelvic positioners and lateral positioners is that they are usually clamped to the side edges or rails on opposed sides of the operating table directly across from the hip area of the patient and directly in front of the operating surgeon with the clamps disposed at or below the surgeon's waist. Most conventional operating table clamps have a protruding knob or lever. Thus, the position of the clamps and protruding knob or lever produce a hazard and obstruction. The surgeon may come into bodily contact with the clamp or protruding knob or lever during the operation which can cause movement of the patient or injury to the surgeon, or can snag the surgeons clothing or gown during movement of the surgeon.
Still another problem with conventional pelvic positioners and lateral positioners is that the elongate rigid rod or arm that is clamped to the side edges or to rails on the opposed sides of the table and/or the pad supports that engage the anterior and posterior pelvic region of the patient may be made of metallic material which will often prevent good x-rays from being taken during the surgical procedure.
Another problem associated with hip and pelvic surgery wherein the patient is supported in a position lying on one side on an operating table is that the patient's face and upper body may be draped with a sheet but is otherwise unprotected. Thus, the patient may be injured by a surgical instrument being passed over his or her face or upper body, or by a surgical instrument that may be accidentally dropped during the surgical procedure.
There are several patents that disclose various work platforms, supports, and pelvic positioner apparatus that are attached to an operating table.
Linder, U.S. Pat. No. 4,113,218 discloses an adjustable frame assembly for attachment to the sides of a hospital operating table for supporting a removable surgical tray above the operating table and over the patient in a variety of positions for the convenience of personnel. The frame assembly consists of two upright supporting columns, one attached to each side of the operating table at an appropriate position. A horizontal bar is mounted between the upper ends of the upright supporting columns and extends across the operating table from one side to the other. A rectangular open frame member is supported by mechanical linkages to a pair of vertically-extending posts adjustably mounted, respectively, upon two slidable blocks carried by the horizontal bar. A removable surgical tray may be placed upon the open rectangular frame and clamped into position. The position of the surgical tray may be raised and lowered over the patient, may be moved about in a plane, or may be tilted or inclined as necessitated by the nature of the operation to increase the convenience, efficiency, and speed in the use of the surgical instruments placed upon the tray. There is no provision for positioning the patient, or for supporting an arm of the patient.
Lee, U.S. Pat. No. 4,180,254 discloses a surgical apparatus for locating a patient lying on his side to facilitate hip surgery which has a first platform to support the patient's lower hip, two posts upstanding from respectively opposite sides of this platform to engage the patient about the rear and front of his pelvis, a second platform extending from the first platform to support the patient's lower leg, at least one further post upstanding from the second platform, and a third platform connected to the further post above the second platform to support the patient's upper leg.
Evans, U.S. Pat. No. 4,390,011 discloses an adjustable surgical arm rest and instrument platform for supporting the arms and hands of a surgeon during a micro-surgical procedure, in which a supporting platform is provided with vertical and angular adjustment mechanisms which permit rapid adjustment of the platform before, during and after the operation. Two or more platforms may be used, and each platform can be adjusted independently of the other platforms. The angular adjustment of a platform can be performed independently of the vertical adjustment of the platform. Each mechanism is provided with a two part securing feature so that the platforms will not move accidentally.
Arnold, U.S. Pat. No. 4,583,725 discloses a patient support frame for use on an operating table during posterior lumbar laminectomy surgery that has a frame for attachment to the table and a pair of iliac crest supports slidably mounted on the frame. The iliac crest supports are adjustable to engage the iliacs, or hipbones, of the patient whereby the prone patient is supported so that the abdomen does not touch the table and is substantially without pressure thereon.
Mullin et al, U.S. Pat. No. 4,624,245 discloses a device for laterally displacing a femur from a hip socket which includes a mount for attachment to a stationary surface, such as a surgical table, a member for exerting pressure against the femur when the member is placed in a predetermined position in contact with the patient, and an assembly for moving the member relative to the mount. Movement of the member permits a sufficient amount of pressure to be exerted and maintained against the femur to laterally displace it from the hip socket.
Kurland, U.S. Pat. No. 4,653,482 discloses an upper-extremity traction tray attachment for operating tables which provides horizontal support form the arm, wrist and hand, or leg of a patient during surgical operations on those parts of the body. The tray comprises a perimetric rectangular metal frame having a pair of spaced-apart, downward-facing, L-shaped projections on each side. Any side of the frame may be secured to the side rail of a typical operating table by securing any of the projection pairs to the side rail on either side of a typical operating table with the common screw-type clamps which may be anchored at any point along the rail. A rigid rectangular sheet of material transparent to both X-rays and visible light spans the gap between the two longitudinal frame sections, a gap being left at either end between the lateral edges of the sheet and each lateral frame section. Traction pulley mounting arm and adjustable support leg assemblies or adjustable support leg assemblies may be mounted on either or both lateral frame sections. The sheet of transparent material has a lateral slot near one end. An elbow post may be slidably mounted at its base within the slot. There is no provision for positioning the patient, or for supporting an arm of the patient.
Tari et al, U.S. Pat. No. 4,858,903 discloses a hand surgery operating table connectable to a conventional main operating table and consisting of a forearm support that is rotatable in a horizontal plane as well as pivotable about a horizontal axis, and a base plate carrying a hand support; and up to seven flexible and tensionable arms secured at one end to the base plate and carrying finger-fixing thimbles at the other end. The tension of the arms can be adjusted to any desired extent so that they can either maintain their tensioned fixed position or they can be readily displaced therefrom without having to manipulate their tensioning mechanism.
Deluhery, U.S. Pat. No. 5,040,546 discloses a portable positioning device for supporting and holding a patient in a lateral decubitus position on the table of a densitometer or the like which includes a rigid back support having a vertical wall, a buttocks support having a vertical wall extending laterally at an angle relative to the vertical wall of the back support and a restraining means such as a flexible strap for holding the patient against these vertical walls.
Michelson, U.S. Pat. No. 5,135,210 discloses a surgical armboard attachment device that permits enhanced adjustability of a conventional surgical armboard. The attachment device permits adjustment of the armboard in three planes, and can be used as an adaptor to an existing armboard, or incorporated as a component of a new armboard structure.
Kabanek et al, U.S. Pat. No. 5,152,486 discloses a surgical assistance device used by members of the surgical staff as an arm or hand rest, instrument platform or sterile cloth support. The surgical assistance device has two rectangular shaped platforms covered by a covering capable of being sterilized. The platforms are attached so that the first platform runs parallel to the patient-supporting surface of the surgical table. The second platform is attached to the first platform and is oriented to the first platform at other than a 180-degree angle. The bottom surface of the first platform is attached to a mounting means for securing the surgical assistance device to the longitudinal support surface of a surgical table.
The present invention overcomes the above described problems and is distinguished over the prior art in general, and these patents in particular by a hip grip table attachment apparatus for positioning and retaining a patient in a position lying on one side during hip or pelvic surgery which is releasably attached to an operating table and has a removable top platform for supporting surgical instruments that extends over and protects the upper body of a patient lying on one side, an arm support attachment that supports an arm of the patient to prevent rolling, and pelvic positioner attachments that position and retain and the patient's lower pelvic region.